Department of Health and NHS criticised
for making too little progress
tackling key barometer of inequality
Denis Campbell, health correspondent
The Guardian, Friday 2 July 2010
This article appeared
on p1 of the Main section section
of the Guardian
Friday 2 July 2010.
It was published on guardian.co.uk
at 00.05 BST
on Friday 2 July 2010.
It was last modified at 00.05 BST
on Friday 2 July 2010.
The life expectancy gap between rich and poor people in England is widening,
despite years of government and NHS action, a hard-hitting National Audit Office
report reveals today.
Extensive efforts have failed to reduce the wide differential, which can still
be 10 years or more depending on socio-economic background, says the public
spending watchdog. While life expectancy has risen generally, it is increasing
at a slower rate for England's poorest citizens.
In Blackpool, for example, men live for an average of 73.6 years, which is 10.7
fewer than men in Kensington and Chelsea in central London, who reach 84.3
years. Similarly, women in the Lancashire town typically die at 78.8 years –
10.1 years earlier than those in the London borough, who reach an average 89.9.
The gap in life expectancy between government-designated areas of high
deprivation and the national average has continued to widen, so Labour's aim of
reducing it by 10% will not be met, the NAO concludes. The failure to meet the
target has cost an estimated 3,300 lives.
The report criticises the Department of Health and the NHS for making too little
progress to tackle this key barometer of inequality. Although the DoH set a
target in 2000 to reduce health inequalities and published a strategy in 2003,
real NHS action did not begin until 2006, it says.
"The Department of Health has made a concerted effort to tackle a very difficult
and long-standing problem," said Amyas Morse, head of the NAO.
"However, it was slow to take action and health inequalities were not a top
priority for the NHS until 2006."
The service was also slow to apply three key policies, including giving more
poor people drugs to reduce their blood pressure or cholesterol level. "These
have yet to be adopted on the scale required to close the inequalities gap," the
The report also highlights a continuing lack of GPs in poor areas with high
health need, despite shortages having been identified as a problem in 2000. It
is also unclear whether an extra £230 a head spent in some areas to improve
health outcomes has had any real impact.
Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said
the disparities showed the inequality of English society. "If we see ourselves
as a civilised society, these gaps are an indication of unfairness, which
shouldn't be there, and is an unfairness which costs lives, damages people's
health and will eventually be a huge burden on the NHS if they aren't tackled,"
But the NAO report did contain good news about improvements in the health of
England's poorest citizens, he added. "The health of the people in the poorest
areas is going in the right direction – that's good news. We shouldn't regard
that as a failure. But the bulk of the population are improving their health at
a faster rate." He urged ministers to resist any temptation to cut spending on
health inequalities in the tough financial climate.
Anne Milton, the public health minister, emphasised the government's belief in
health equality. "Everyone should have the same opportunities to lead a healthy
life no matter where they live. We want the public's health to be at the very
heart of all we do, not just in the NHS but across government," she said.
"This report shows that efforts have been made to address health inequalities
but that more needs to be done to tackle the deep-rooted social problems that
cause ill-health. I want to see the NHS, doctors and local government acting at
the right time to improve the health of those who need it most."
The NHS Confederation, which represents most health service organisations,
admitted that more progress was needed. Jo Webber, its deputy policy director,
said: "The NHS and its partners, especially in local government, have a
responsibility to help stop people falling into and continuing in ill-health
rather than picking up the pieces when it may be too late. Encouraging improved
health requires a focus on all aspects of society, including economic
inequality, and quality of life in early years."
Tammy Boyce, of the King's Fund health thinktank, said the NHS could only
achieve so much. "Tackling health inequalities is not a task for the NHS alone.
It requires a co-ordinated, long-term commitment across government to address
the wider causes of ill health such as poverty and poor housing," she said.
"The first test of whether the coalition government is likely to succeed where
the previous government failed will come in this autumn's spending review. It is
vital that cross-cutting issues like health inequalities are not overlooked in
the scramble to deliver spending cuts on a department-by-department basis."
Michelle Mitchell, charity director at Age UK, said the big gap in life
expectancy had to be tackled in the light of the government's intention to
increase the age at which people can draw the state pension. "With a 13-year
disparity in life expectancy between different areas of the country, it's
shocking that primary care trusts are still failing to use simple and effective
treatments to help tackle the problem.
"This report follows the government's announcement last week to raise the state
pension age further and faster, which will hit those with a shorter life
expectancy in the poorest areas of Britain hardest," she said. "In this context,
tackling health inequalities is more urgent than ever and the government must
set ambitious targets to close the yawning life expectancy divide."